Provider Demographics
NPI:1063176261
Name:RUBENSTEIN, ELSA ABIGAIL
Entity type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:ABIGAIL
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:ABIGAIL
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 COLLEGE AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4118
Mailing Address - Country:US
Mailing Address - Phone:707-494-2059
Mailing Address - Fax:707-595-5951
Practice Address - Street 1:201 ALAMEDA DEL PRADO STE 201
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6698
Practice Address - Country:US
Practice Address - Phone:415-798-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty